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. 2024 Mar 4;120(12):e20230409.
doi: 10.36660/abc.20230409. eCollection 2024.

Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

[Article in Portuguese, English]
Júlia Cândido  1 , Lidyane do Valle Camelo  1 , Luisa Brant  1 , Roberto Sá Cunha  2 , José Geraldo Mill  2 , Sandhi Maria Barreto  1
Affiliations

Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

[Article in Portuguese, English]
Júlia Cândido et al. Arq Bras Cardiol. .

Abstract
in English, Portuguese, Portuguese

Background: Central Illustration : Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study.

Background: Arterial stiffening can directly affect the kidneys, which are passively perfused by a high flow. However, whether the relation between arterial stiffness and renal function depends on diabetes and hypertension conditions, is a matter of debate.

Objective: To investigate the relationship between arterial stiffening by carotid-to-femoral pulse wave velocity (cfPWV) and chronic kidney disease (CKD) incidence in individuals and verify whether this association is present in individuals without hypertension and diabetes.

Methods: A longitudinal study of 11,647 participants of the ELSA-Brasil followed up for four years (2008/10-2012/14). Baseline cfPWV was grouped per quartile, according to sex-specific cut-offs. Presence of CKD was ascertained by glomerular filtration rate (eGFR-CKD-EPI) < 60 ml/min/1.73 m2 and/or albumin-to-creatinine ratio ≥ 30 mg/g. Logistic regression models were run for the whole cohort and a subsample free from hypertension and diabetes at baseline, after adjustment for age, sex, race, schooling, smoking, cholesterol/HDL ratio, body mass index, diabetes, use of antihypertensive, systolic blood pressure, heart rate, and cardiovascular disease. Statistical significance was set at 5%.

Results: The chance of CKD was 42% (CI 95%: 1.05;1.92) greater among individuals in the upper quartile of cfPWV. Among normotensive, non-diabetic participants, individuals in the 2nd, 3rd, and 4th quartiles of cfPWV presented greater chances of developing CKD, as compared to those in the lower quartile, and the magnitude of this association was the greatest for those in the upper quartile (OR: 1.81 CI 95%: 1.14;2.86).

Conclusion: Higher cfPWV increased the chances of CKD and suggests that this effect is even greater in individuals without diabetes and hypertension.

Figura Central : Maior Rigidez Arterial Prediz Doença Renal Crônica no Estudo de Coorte ELSA-Brasil.

Fundamento: A rigidez arterial pode afetar diretamente os rins, que são perfundidos passivamente por alto fluxo. No entanto, determinar se a relação entre rigidez arterial e função renal depende das condições de diabetes e hipertensão é uma questão controversa.

Objetivo: Investigar a relação entre a rigidez arterial, por velocidade da onda de pulso carotídea-femoral (VOPcf), e a incidência de doença renal crônica (DRC) em indivíduos e verificar se essa associação está presente em indivíduos sem hipertensão e diabetes.

Métodos: Estudo longitudinal com 11.647 participantes do ELSA-Brasil acompanhados por quatro anos (2008/10-2012/14). A VOPcf basal foi agrupada por quartil, de acordo com pontos de corte específicos com relação a sexo. A presença de DRC foi verificada pela taxa de filtração glomerular (TFGe-CKD-EPI) < 60 ml/min/1,73 m2 e/ou relação albumina/creatinina ≥ 30 mg/g. Modelos de regressão logística foram executados para toda a coorte e uma subamostra livre de hipertensão e diabetes no início do estudo, após ajuste para idade, sexo, raça, escolaridade, tabagismo, relação colesterol/HDL, índice de massa corporal, diabetes, uso de anti-hipertensivos, pressão arterial sistólica, frequência cardíaca e doenças cardiovasculares. A significância estatística foi fixada em 5%.

Resultados: A chance de DRC foi de 42% (IC de 95%: 1,05;1,92) maior entre indivíduos no quartil superior da VOPcf. Entre os participantes normotensos e não diabéticos, os indivíduos do 2º, 3º e 4º quartis da VOPcf apresentaram maiores chances de desenvolver DRC, quando comparados aos do quartil inferior, sendo a magnitude dessa associação maior para aqueles do quartil superior (OR: 1,81 IC de 95%: 1,14;2,86).

Conclusão: A maior VOPcf aumentou as chances de DRC, e sugere que esse efeito é ainda maior em indivíduos sem diabetes e hipertensão.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura Central
Figura Central. : Maior Rigidez Arterial Prediz Doença Renal Crônica no Estudo de Coorte ELSA-Brasil
Figura 1
Figura 1. – Fluxograma de critérios de exclusão.
Figura 2
Figura 2. – Incidência cumulativa de doença renal crônica (DRC) após aproximadamente quatro anos de acompanhamento (2008/2010–2012/2014), segundo quartis de velocidade da onda de pulso específicos para sexo em toda a amostra e na subamostra sem diabetes mellitus e sem hipertensão.
Central Illustration
Central Illustration. : Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study
Figure 1
Figure 1. – Exclusion criteria flowchart.
Figure 2
Figure 2. – Cumulative incidence of chronic kidney disease (CKD) after approximately four years of follow-up (2008/2010–2012/2014), according to sex-specific quartiles of pulse wave velocity in the entire sample and in the subsample without diabetes mellitus and hypertension.
See this image and copyright information in PMC

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